P2158 Fork Bixby RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
_ Permit Number
Name_ ���_�.�. L t r:t... � .:.� Date
Location
C
Subdivision Name Lot No. Sec. or Block No.
Lot Size Mobile Home Business Speculation
No. Bedrooms - No. Baths Z - No. in Family ` 1 �`
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Garbage Disposal YES .C] NO p''
Auto Dish Washer YES r NO Specifications for System:
Auto Wash Machine YES ANO �� `t
Type Water Supply CI
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by Q1 -
*Contact a representative of the Davie County Health Department for final inspection of this system between 8;30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by e -' "�` S.7-
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.7'
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DLie 11
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT j ,„
P. 0. BOX 57 Z/%1
MOCKSVILLE, N. C. 27028 3��L
aloz
(704) 634-5985 9-114
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME zCM & DATE ISSUE -DS --2a-77
ADDRESS PERMIT NO. 0?15E'
Explanation of chargeAi�,��..
AMOUNT DUE ?D•A SANITARIAN 4- a
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION 'PEST RESULTS
DATE -5 - as --11
NXIM �A,.j
LOCATION r-ut K J"� rzr�--
FINDINGS:
LOT DIAGAW. 1
HOLE 110.
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COPMENTS
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